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Left Ventricular Aneurysm Repair Through the Left Anterior Minithoracotomy
Oleksandr Babliak1, Dmytro Babliak1, Vasyl Lazoryshynets2
1Cardiac Surgery Department, Diagnostic and Treatment Center For Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine.
Insights
Left ventricular aneurysm (LVA) repair using left anterior thoracotomy is a safe and effective minimally invasive surgical option. This technique, often combined with coronary artery bypass grafting (CABG) and mitral valve (MV) surgery, shows promising results with low complication rates.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracic Surgery
Background:
- Left ventricular aneurysms (LVAs) are serious post-infarction complications.
- Traditional surgical repair often involves sternotomy, which can lead to longer recovery times.
- Minimally invasive approaches are increasingly sought for cardiac procedures.
Purpose of the Study:
- To detail the surgical technique for left ventricular aneurysm (LVA) repair.
- To evaluate the outcomes of LVA repair performed via left anterior thoracotomy.
- To assess the feasibility of combining LVA repair with coronary artery bypass grafting (CABG) and/or mitral valve (MV) surgery.
Main Methods:
- A cohort of 40 patients with postinfarction LVA underwent repair via left anterior thoracotomy.
- Simultaneous procedures included CABG (100%) and MV surgery (37.5%).
- The technique involved peripheral cardiopulmonary bypass, minithoracotomy, aortic cross-clamping, and cold blood cardioplegia.
Main Results:
- Successful LVA repair and complete revascularization were achieved in all patients without conversion to sternotomy.
- Mean cardiopulmonary bypass and cross-clamp times were 207 and 115.5 minutes, respectively.
- Low complication rates were observed, with an average ICU stay of 2.1 days and no strokes or hospital mortality (1 patient with 30-day mortality).
Conclusions:
- Left ventricular aneurysm repair, including combined procedures, via left anterior thoracotomy is an efficient and safe surgical approach.
- This minimally invasive technique offers a viable alternative to sternotomy for LVA management.
- The study demonstrates favorable short-term outcomes for this procedure.
Objective:
To describe the technique and the results of left ventricular aneurysm (LVA) repair with simultaneous coronary artery bypass grafting (CABG) and/or mitral valve (MV) surgery through the left anterior thoracotomy.
Methods:
Between October 2018 and June 2024, a cohort of 40 patients underwent repair for postinfarction LVA through left anterior thoracotomy. Simultaneous procedures included CABG (40 patients, 100%) and MV surgery (15 patients, 37.5%) and were performed through the same thoracotomy incision. The mean age of the patients was 61.4 ± 11.4 years (range, 33 to 82 years), the mean body mass index was 27.9 ± 4.3 kg/m2 (range, 19.9 to 35.9 kg/m2), and the mean LV ejection fraction was 29.9% ± 8.6% (range, 10% to 55%). The surgical technique in all patients included peripheral cardiopulmonary bypass, minithoracotomy in the fourth intercostal space, aortic cross-clamping, and cold blood cardioplegia.
Results:
Successful visualization and repair of the LVA and complete revascularization was achieved in all patients without conversion to sternotomy. The mean number of distal anastomoses per patient was 2.03 ± 1.12 (range, 1 to 5). The mean cardiopulmonary bypass time was 207 ± 51.0 min, and the mean cross-clamp time was 115.5 ± 28.7 min. The average intensive care unit stay was 2.1 ± 1.4 days (range, 1 to 8 days), and the total hospital stay was 6.8 ± 2.9 days (range, 4 to 14 days). No strokes, major complications, or hospital mortality were observed. The 30-day mortality included 1 patient.
Conclusions:
LVA repair (isolated or combined with simultaneous cardiac surgical procedures) through the left anterior thoracotomy is shown to be efficient and safe in our experience.
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